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(CNN) - More than 3.5 million children use medications like Ritalin and Adderall to treat Attention-deficit/hyperactivity disorder, or ADHD.
But authors of one of the most influential studies that first trumpeted the effectiveness of these drugs in the 1990s say they worry the results over-sold the benefits of using the drugs alone, without other forms of therapy.
"Subsequent publications where we looked more broadly at academics and social skills and family discipline styles, showed the clear and superior benefits of combining the medications with active family and school behavior therapy," said professor Steven Hinshaw. Hinshaw was a researcher in the influential 1990s study.
One of the study's co-authors told The New York Times, "I hope it didn't do irreparable damage.The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this."
Hinshaw said ADHD is a real condition, but diagnosis takes "a careful, thorough work up." That is, a 10-minute doctor's visit is not enough to determine if a child suffers from the disorder.
"If medication is prescribed, we have to evaluate carefully whether it works or not," said Hinshaw.
"It really takes skill building, not just symptom reduction, to give the best outcomes for kids and adolescents and adults who really need it," said Hinshaw.
One in seven children in the U.S. receive a diagnosis of ADHD by the time they turn 18. Hinshaw said "it is possible" the disorder has been overdiagnosed.
"There is also pressure academically on kids these days. There is also pressure for too often a quick and dirty diagnosis without the thorough history and testing that's needed," said Hinshaw. "That's a recipe for, in too many cases, overdiagnosis.
"Yet at the same time, too many kids with mental health problems in the United States are getting no treatment at all. So we're both over and underdiagnosing," said Hinshaw. "We have to empower doctors and reimburse the kinds of assessments needed to make sure that we're accurate with all this."